Esophagitis, Hiatus Hernia, "GERD" and Ulcer Disease

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Esophagitis (Inflammation of the Esophagus or Gullet), Hiatus Hernia, "GERD", and Ulcer Disease

The esophagus is a tube that connects the mouth to the stomach. Reflux of stomach contents and acid into the lower esophagus causing "esophagitis" occurs in Hiatus Hernia and other conditions. Such reflux can be serious leading to Barrett's Esophagus/scarring/ulcers/pain and burning/gas.

The more of these rules below that you follow, the better you will feel:

  • Eat small, equal-sized and frequent meals, but do not gain weight. Eat your smallest meal at supper, your lasagna at lunch.
  • Lose weight down to trim - fat in the abdomen compresses the stomach and will increase your problem. Weight gain can markedly increase symptoms.
  • What foods you eat can be important, so avoid greasy and oily foods that tend to remain in the stomach like meat/cheese/fried foods/pizza/eggs. Also avoid those foods that you know cause your problems.
  • Sweets and desserts can make you hungry and that will make you eat more, increasing your symptoms. You may find that orange juice, cayenne pepper are troublesome - avoid.
  • If your problems occur after meals, take your liquids between meals rather than with them. Distention of your stomach is an important factor pushing the acid from the stomach up into your esophagus.
  • Loosen clothing and tight belts after meals.
  • Avoid any type of regular or decaf coffee. Many sodas and instant ice teas contain large amounts of caffeine and caffeine does stimulate acid production, thereby increasing your symptoms. Reduce these.
  • Regarding smoking, nicotine in any form is a specific relaxer of the lower esophageal closing mechanism and therefore allows acid reflux into the lower esophagus.
  • Beer and soft drinks cause air swallowing and acid burping - avoid.
  • When using antacids in tablet form, chew one and let one melt in the mouth like a Life Saver. Tums are to be used only a few times. Also available over the counter consider using activated charcoal, Gaia Sweetish Bitters, Pepto-Bismol, Zantac 75 1-2 twice a day (preferred over Pepcid or Tagamet), mastic and DGL (deglycyrrhizinated licorice). "Active" manuk honey (from New Zealand) and mastic have been proven to kill H. pylori: 1 tablespoon on a small piece of bread 1 hour before meals and at bedtime for 30 days. Baking soda (soda bicarbonate) is to be avoided as this can cause kidney stones and high blood pressure.
  • If you nap near meals, do this before, not after meals. Lying flat with a full stomach is one of the worst things you can do. Go to bed on an empty stomach! Eat early and do not eat for four hours, do not drink anything for two hours, before retiring. No bedtime milk.
  • Not as effective, but also helpful is a "bed wedge" available at health-product supply stores. Place six-inch blocks under the head of your bed so that gravity will drain the esophagus while you sleep. GI Bed Blocks raise the bed perfectly and are available by calling 800-442-5625.
  • Avoid voluntary belching. This brings stomach contents up into the esophagus. Belch only naturally, do not force. Soft drinks and beer make this much worse because of their volume and bubbly effects.
  • An exercise program is always desirable but sit-ups, working in the garden, scrubbing floors on hands and knees and other exercises that compress the abdomen or sharply bend the waist should be done before meals, using prophylactic DGL, antacids or Zantac before these activities. When you bend down, do so at the knees with a straight back so that you squat and do not bend at the waist.

Ulcer disease can occur from childhood into the 80's, usually from ages 20 through 50. Generally this is an uncomfortable, rather than a life-threatening, disorder. Ulcer symptoms are a burning or aching pain just below the breastbone in the upper belly. This frequently feels "hot" or "gnawing" and can go straight through the back. These are the usual, but not the only, symptoms that accompany the condition of excess acid. If you have these symptoms, they are much more likely to be caused by an excess of acid than ulcer disease. See your doctor if you are not sure.

A bacteria called H. pylori may be present and need to be treated in most ulcer patients. If positive, you will likely require Prilosec + Flagyl + antibiotics + Pepto-Bismol, or Active Manuk Honey/Mastic/DGL as mentioned above.

Treatment of excess acid is fairly easy. Limit alcohol (whiskey, wine or beer) and omit coffee. Try Inka or Raja's Cup if you wish to have coffee-like drink or use 1-2 tea bags of "One World brand English Breakfast" tea and you won't need the coffee. It's amazing how easily you can change over. Abstain if you can from even decaf coffee.

Completely stop aspirin, APC'S, Excedrin, and even Advil/ibuprofen/Naproxen and colas. Call your doctor to see if you are on medications that can cause or increase your symptoms.

Excesses can even irritate the stomach of normal people. Interestingly, being overweight makes these ulcer (peptic) symptoms worse.

Your best diet for whole health is a "liv-it" of fresh, whole and unprocessed organic, very high fiber/low fat foods. It is unimportant to avoid small amounts - that is, do avoid large amounts - of any spices, other foods or beverages, unless they specifically upset your stomach. It is your ulcer, your pain, and your choice. You will make yourself feel better if you follow the above directions.

If your doctor so directs you, good antacids are activated charcoal, DGL, or Zantac 75, and Pepto-Bismol. Particularly if you are known to have excess acid or an ulcer, you should immediately call your doctor if you vomit blood or have a black, sticky bowel movement and are not being treated with iron or Pepto-Bismol, both of which cause black but not sticky, stools. Profound increase or unusual persistence of your pain should likewise lead you to call your doctor.


H. Robert Silverstein, MD
Hartford, CT

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